The Loss of Physician Respect

Physician Burnout—Over 54% of physicians experience it. In fact, the WHO now officially recognizes work “burnout” as an occupational phenomenon. The syndrome is included in the agency’s handbook of medical diagnoses, which guides health professionals around the world.

Symptoms of burnout include: feelings of exhaustion, cynicism about one’s job, and difficulty doing the job successfully. Burnout is defined as a syndrome resulting from “chronic workplace stress that has not been successfully managed.”Maslach Burnout Inventory (MBI), a standardized instrument with 22 questions, usually measures burnout.

Physician burnout has consequences for our patients, physicians and the health care system. Physician burnout has been linked toincreased medical errors, lower patient satisfaction scores, and increased malpractice risk. Studies show that  $4.6 billion in costs and reduced clinical hours are related to physician turnover annually in the United States.  At an organizational level, this translates to approximately $7600 per employed physician each year.

A recent study shows that physician compensation is not related to our burnout, but instead the issue of RESPECT.

That is feeling valued, being treated with respect and being a part of supportive work environment is important to prevent physician burnout.  In academia, greater physician satisfaction with work is linked to the quality of care delivered, faculty retention and patient satisfaction.  Work environments and toxic cultures that promote gender discrimination are obviously associated with decreased physician satisfaction and higher risk of burnout. 

With the changing culture of medicine, physicians are losing more and more autonomy.  How many physicians feel that their concerns and expertise are not listened to in meetings? The physicians are usually the people who have been with their respective organizations longer than most administrators, yet many times, our voices are not acknowledged at the table, thereby impacting the health care system and patient care.  Who else is best equipped to know about aspects of health care than us, the physician? 

Unfortunately, hospital leadership is rarely comprised of physicians, but by those who have backgrounds in administration, business or nursing. In 1935, out of 6500 hospitals, over 2300 of the hospitals were led by physicians.  Fast forward to 2008, where less than 3% of over 5000 hospitals are led by physician CEOs. And only 10% of physicians comprise senior leadership.

With the ballooning costs of healthcare related to increased administrative salaries coupled with decreasing physician autonomy, the issue of burnout in our profession will unlikely be addressed with real-world solutions anytime soon.  In order to get back control, as physicians, we need to start taking leadership positions while giving adequate time for physicians to train to become physician leaders. It is only then, we will see positive change in the US healthcare system.   

Natasha Sriraman MD

Dr. Sriraman, MD, MPH, FAAP, FABM, speaks around the country on various topics: breastfeeding, postpartum depression screening in pediatrics, narrative medicine/physician burnout, cultural competency/cultural differences in infant feeding and social determinants of health. She has specialized training in pediatric psychopharmacology. In addition to seeing patients, she is an associate professor of pediatrics at Eastern Virginia Medical School and teaches medical students and residents daily. She also holds a master's degree in public health from the University of Pittsburgh and has designed curriculum for public health training in pediatrics and breastfeeding training. She also serves as Adjunct Lecturer at the College of William & Mary where she teaches a class on health disparities.. Dr. Sriraman is frequently involved with legislative advocacy and has worked with the Governor's office on having May declared as Maternal Mental Health Month in Virginia. She has received numerous awards for her teaching and research. She has also received grants from Health Resources and Services Administration (HRSA), the American Academy of Pediatrics (AAP) and jointly from Williams & Mary College/Eastern Virginia Medical School. She has served on the board of National AAP-Section of Breastfeeding, and VA-AAP Chapter, and Postpartum Support Virginia. She is currently on the Board of Directors for Academy of Breastfeeding Medicine and The Eliza Hope Foundation. 

  6 comments for “The Loss of Physician Respect

  1. June 5, 2019 at 10:30 am

    Declare independence now. “When you reach out with your hand to take the money, that’s when they snap on the handcuffs,” said the late R.S. Jaggard (“Jag”) of AAPS.

  2. RSW
    June 5, 2019 at 10:15 am

    “With the changing culture of medicine, physicians are losing more and more autonomy.”

    The ongoing loss of autonomy combined with a continued and increasing liability for all actions, both of oneself and others, is an explosive situation.

    It’s only going to get worse.

  3. Rick Singel
    June 4, 2019 at 3:04 pm

    Administration listening to the “boots on the ground” is akin to the government listening to the citizens. They just don’t care. Shut up and generate revenue.
    Medicine is doomed since the businessmen took over.
    The sole answer is to break the bonds of indentured service.

    • Judy Harvey
      June 5, 2019 at 2:58 pm

      Young physicians are on average $400k in debt when they start residency. They will be stuck in indentured servitude doing a job they hate and be supervised by a non physician administrator who shows no respect for their expertise. They will be chained to an EMR skewed for billing and government mandated documentation.

      We need a revolution. Or at least a union.

  4. Pat
    June 4, 2019 at 2:49 pm

    “You question the validity of the mission. Thus you question the validity of the missionary. A loss of faith. That is corrosive. At that point you question existence itself, the meaning of it. A common human condition. Those with no imagination never really feel despair. Congratulations!”

    – Meyer in “The Empty Copper Sea”, by John D. MacDonald

  5. June 4, 2019 at 1:34 pm

    Burnout is likely a manifestation of toxic workplace syndrome. There is a solution: See “Fulfillment v. Burnout” Declare independence. More and more doctors are doing it. They explain how and why:

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